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论著:腹腔镜与开腹全直肠系膜切除术治疗中低位直肠癌的近期疗效比较
Evaluation of Short Term Outcomes of Laparoscopic and Open Total Mesorectal Excision for Mid and Distal Rectal Cancer
施德兵 李心翔 蔡三军 顾卫列 肖长春 莫善兢
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作者单位:复旦大学附属肿瘤医院大肠外科
中文关键字:直肠癌;腹腔镜手术;全直肠系膜切除术
英文关键字:Rectal cancer;Laparoscopic surgery;Total mesorectal excision
中文摘要:目的:比较腹腔镜与开腹全直肠系膜切除(total mesorectal excision, TME)术治疗中低位直肠癌的近期疗效。方法:回顾分析2008年9月—2011年7月因中低位直肠癌行腹腔镜TME术(腹腔镜组)67例及行开腹TME术(开腹组)71例患者的临床资料,包括手术相关指标、术后恢复相关指标、肿瘤根治性指标、围手术期并发症等。结果:腹腔镜组与开腹组手术保留肛门率分别为65.7%(44/67)和60.6%(43/71);2组手术时间分别为(176.4±68.3)min、(122.7±42.5)min;2组术中出血量分别为(86.9±37.6)mL、(119.1±32.7)mL,2组比较差异均有统计学意义(P<0.05)。2组术后镇痛时间、排气时间、留置导尿管时间及术后住院时间差异也有统计学意义;2组切除标本长度分别为(18.4±4.23)cm、(19.7±6.17)cm,肿瘤距下切缘距离分别为(3.6±1.9)cm、(3.3±1.7)cm。2组清扫淋巴结数目分别为(20.3±8.3)cm、(21.1±6.7),差异均无统计学意义(P>0.05)。2组环切缘受累情况类似;腹腔镜组有2例中转开腹( 2.99%)。围手术期并发症腹腔镜组4例,开腹组6例,2组比较差异无统计学意义(P>0.05)。结论:腹腔镜中低位直肠癌TME术的近期疗效与开腹TME术相当,且具有创伤小、出血少、术后疼痛轻、胃肠功能及泌尿功能恢复快、并发症少和术后住院时间短等优势。
英文摘要:Objective:To evaluate the difference of short term outcomes between laparoscopic total mesorectal excision and open operation for mid and distal rectal cancer.Methods: A total of 138 patients with mid lower rectal cancer were randomly assigned to laparoscopic surgery group (n=67) and open surgery group (n=71) from September 2008 to July 2011. Data about the patients’ demographics, operative details and postoperative outcomes were collected retrospectively. Comparison of the short term outcomes was performed between the two groups.Results: Anterior resection was performed in 65.7%(44/67)patients of the laparoscopic surgery group and 60.6%(43/71)patients of the open surgery group. The operating time of the laparoscopic surgery group [(176.4±68.3) min] was longer than the open surgery group [(122.7±42.5) min], and the difference is significant (P<0.05). The blood loss in the laparoscopic surgery group [(86.9±37.6)ml] was less than the open group [(119.1±32.7)ml], and the difference is significant (P<0.05). Patients undergoing laparoscopic resection had a shorter analgesic time, an earlier return of bowel function, a shorter indwelling catheter time, as well as a shorter hospital stay. There were no significant differences in the number of lymph nodes harvested, specimen length, the rate of positive circumfeential margins, as well as the length of distal margin between the two groups. Conversion to conventional surgery was necessary in two cases (2.99%). There were no significant differences in the rate of perioperative complications between the two groups, four in the laparoscopic surgery group and six in the open surgery group.Conclusions: Compared with open operation, laparoscopic TME for mid and distal rectal cancer is a safe and effective option for less blood loss, faster recovery, less pain, less postoperative complications and short hospitalization, while the short term outcomes of the two methods is similar.
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